Wieder J A, Soloway M S
Department of Urology, University of Miami School of Medicine, Florida, USA.
J Urol. 1998 Aug;160(2):299-315.
During radical prostatectomy for prostate cancer tumor at the surgical margin is a relatively frequent finding. We summarize the literature on the incidence, etiology, location, prevention and treatment of positive surgical margins after radical prostatectomy.
The literature was reviewed for data on positive margins during radical prostatectomy for prostate cancer.
Positive surgical margins may result from artifacts induced by tissue processing, incising inadvertently into the prostate or incising into extraprostatic tumor that has extended beyond the limits of resection. Patients with 10 ng./ml. or greater preoperative prostate specific antigen, biopsy Gleason score 7, multiple positive biopsies, or clinical stage T2b, T2c or T3 cancer have a higher risk of positive margins. Preoperative endorectal magnetic resonance imaging may be useful in staging a select group of patients. Neoadjuvant androgen deprivation reduces the incidence of positive margins but does not appear to delay progression or improve survival. The surgical approach, retropubic or perineal, may influence the location and etiology of positive margins. In general, nerve and bladder neck sparing procedures do not compromise tumor removal in appropriately selected patients. Positive margins increase the risk of progression and correlate with decreased cancer specific and overall survival. There is no consensus on the management of positive margins. External beam radiation and androgen deprivation may be administered as adjuvant therapy or at the time of recurrence.
Tumor at the specimen edge is an adverse prognostic factor. With appropriate patient selection and meticulous surgical technique some positive margins can be prevented. Controlled prospective randomized studies of postoperative therapy are needed before definitive recommendations can be made for treating positive margins.
在前列腺癌根治性前列腺切除术期间，手术切缘发现肿瘤是较为常见的情况。我们总结了关于根治性前列腺切除术后手术切缘阳性的发生率、病因、位置、预防及治疗的文献。
回顾文献以获取前列腺癌根治性前列腺切除术时切缘阳性的数据。
手术切缘阳性可能源于组织处理引起的假象、无意中切入前列腺或切入超出切除范围的前列腺外肿瘤。术前前列腺特异性抗原为10 ng/ml或更高、活检Gleason评分7分、多处活检阳性或临床分期为T2b、T2c或T3期癌症的患者，切缘阳性风险更高。术前直肠内磁共振成像可能有助于对部分患者进行分期。新辅助雄激素剥夺可降低切缘阳性的发生率，但似乎不会延迟疾病进展或提高生存率。耻骨后或会阴手术入路可能会影响切缘阳性的位置及病因。一般而言，在适当选择的患者中，保留神经和膀胱颈的手术不会影响肿瘤切除。切缘阳性会增加疾病进展风险，并与癌症特异性生存率及总生存率降低相关。对于切缘阳性的处理尚无共识。外照射放疗和雄激素剥夺可作为辅助治疗或在复发时使用。
标本边缘的肿瘤是一个不良预后因素。通过适当选择患者和采用细致的手术技术，一些切缘阳性情况是可以预防的。在对切缘阳性的治疗做出明确推荐之前，需要进行关于术后治疗的对照前瞻性随机研究。
